title: Clinical characteristics and outcomes of patients with Burkholderia cepacia bacteremia in an intensive care unit.
abstract: The purpose of this study was to investigate a cohort of patients with Burkholderia cepacia bacteremia in the intensive care unit (ICU) at our institution. A large outbreak of B. cepacia bacteremia involving 95 patients lasted for 4 years in an ICU in northern Taiwan. The clinical characteristics and antimicrobial treatment responses of these patients were analyzed. Minimal inhibitory concentrations were determined and pulse-field gel electrophoresis was performed for the 73 available isolates. Overall, the in-hospital mortality rate was 53.8% and the 14-day mortality rate was 16.8%. Most patients (95.6%) had several underlying diseases and all but 1 patient had tracheal intubation. Malignancy (37.5% versus 13.9%, P = 0.02) and higher Sequential Organ Failure Assessment (SOFA) scores at the onset of bacteremia (11.9 ± 4.7 versus 7.9 ± 3.6, P < 0.001) were significant risk factors for 14-day mortality. In contrast, treatment with ceftazidime (76.0% versus 43.7%, P = 0.02) and diabetes (51.9% versus 13.8%, P = 0.01) were associated with decreased mortality. In the multivariate analysis, malignancy and higher SOFA score were significant risk factors for mortality [odds ratio (OR) 12.45, 95% confidence interval (CI) 2.35-65.94; OR 1.20, 95% CI 1.00-1.45, respectively]. Meropenem, ceftazidime, and piperacillin-tazobactam were the most active agents (susceptible rate 100%, 97.3%, and 97.3%, respectively). Pulsed-field gel electrophoresis results indicated 49 of the 73 isolates could be classified as outbreak-related strains. There was no significant difference in the clinical characteristics and outcomes of patients with bacteremia due to outbreak-related and non-outbreak-related strains. In conclusion, malignancy and a higher SOFA score at onset of bacteremia predicted increased mortality, but the clinical presentation and outcome of patients with outbreak and non-outbreak strains were similar.
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County, Taiwan ROC.
authors.forename: Chun-Hsing
authors.initials: CH
authors.lastname: Liao
authors.forename: Hou-Tai
authors.initials: HT
authors.lastname: Chang
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
authors.forename: Yu-Tsung
authors.initials: YT
authors.lastname: Huang
authors.forename: Meng-Shuian
authors.initials: MS
authors.lastname: Hsu
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Liu
authors.forename: Chia-Jui
authors.initials: CJ
authors.lastname: Yang
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D015373:Bacterial Typing Techniques; D019121:Burkholderia Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D016956:Burkholderia cepacia / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D015331:Cohort Studies; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents